INFECTION

PREVENTION AND
CONTROL
SCIENTIFIC KNOWLEDGE BASE
 ENTRY AND MULTIPLICATION OF
ORGANISM RESULTS IN DISEASE
 COLONIZATION OCCURS WHEN A
MICROORGANISM INVADES THE
HOST BUT DOES NOT CAUSE
INFECTION (INJURY TO CELLS)
 PATIENT SAFETY ISSUE
CHAIN OF INFECTION
 Infectious agent or pathogen
 Reservoir
 Portal of exit
 Mode of transmission
 Portal of entry
 Susceptible host
Infectious Agent/Pathogen
 Microorganisms (bacteria, viruses,
fungi, protozoa
 Normal flora
 Colonization
 Virulence
 Susceptibility
 Review Potter & Perry Table 34-1 (pg.
643) Common Pathogens
Reservior
 Animate sources (humans, animals,
insects)
 Inanimate sources (soil, water, food,
medical equipment)
 Pathogens need a proper environment
to survive (food, oxygen, water,
temperature, pH, light)
 Carriers
 Toxins: (Exotoxins, endotoxins)
Portal of Exit/Entry
 Skin and Mucous Membranes
 Respiratory Tract
 Urinary Tract
 Gastrointestinal tract
 Reproductive Tract
 Blood
Modes of Transmission
 Contact (Direct & Indirect)
 Droplet
 Airborne
 Fecal-Oral
 Vectors
 DIRECT TRANSMISSION
Direct contact transmission requires
physical contact between an infected
person and a susceptible person, and the
physical transfer of microorganisms.

• touching an infected individual

• Kissing
• sexual contact
• contact with oral secretions
• contact with body lesions.
 INDIRECT TRANSMISSION
Indirect contact transmission refers to situations where a
susceptible person is infected from contact with a
contaminated surface.

Frequent touch surfaces (fomites) include:

• Door knobs, door handles, handrails
• Tables, beds, chairs
• Washroom surfaces
• Cups, dishes, cutlery, trays
• Medical instruments
• Computer keyboards, mice, electronic devices with buttons
• Pens, pencils, phones, office supplies
• Children's toys
 DROPLET TRANSMISSION
Droplets containing microorganisms can be
generated when an infected person coughs,
sneezes, or talks. Droplets can also be generated
during certain medical procedures, such as
bronchoscopy.
Droplets are too large to be airborne for long
periods of time, and quickly settle out of air.

Droplet transmission can be reduced with the use of personal

protective barriers, such as face masks and goggles. Measles
and SARS are examples of diseases capable of droplet contact
transmission.
 AIRBORNE TRANSMISSION
Airborne transmission refers to situations where droplet nuclei
(residue from evaporated droplets) or dust particles
containing microorganisms can remain suspended in air for
long periods of time. These organisms must be capable of
surviving for long periods of time outside the body and must
be resistant to drying. Airborne transmission allows organisms
to enter the upper and lower respiratory tracts. Fortunately,
only a limited number of diseases are capable of airborne
transmission.

Diseases capable of airborne transmission include:

• Tuberculosis
• Chickenpox
• Measles
 FECAL-ORAL TRANSMISSION
Fecal-oral transmission is usually associated with organisms
that infect the digestive system. Microorganisms enter the
body through ingestion of contaminated food and water.
Inside the digestive system (usually within the intestines)
these microorganisms multiply and are shed from the body in
feces.

 Fish and shellfish that swim in contaminated water may be

used as food sources.
 If the infected individual is a waiter, cook, or food handler, then
inadequate handwashing may result in food being
contaminated with microorganisms.
Fecal-oral transmission can be reduced by:
 Proper storage of food at proper temperatures
 Thorough cooking of food
 Frequent and thorough handwashing, especially
after washroom use
 Adequate sewage treatment and water
filtration/chlorination systems
 Disinfection of frequent touch surfaces to prevent
indirect contact transmission
 Increased public awareness of proper hygiene and
food handling
VECTOR-BORNE TRANSMISSION
Vectors are animals that are capable of transmitting
diseases. Examples of vectors are flies, mites, fleas,
ticks, rats, and dogs. The most common vector for
disease is the mosquito. Mosquitoes transfer disease
through the saliva which comes in contact with their hosts
when they are withdrawing blood. Mosquitoes are vectors
for malaria, West Nile virus, dengue fever, and yellow
fever.

Biting is not the only way vectors can

transmit diseases. Diseases may be spread
through the feces of a vector.
Susceptible Host
 Susceptibility (Resistance to infection)
 Factors which influence susceptible:
 Age
 Nutritional status
 Chronic disease history
 Trauma
 Smoking
The Infectious Process
 Incubation Period
Pathogen is actively replicating without
producing symptoms.
 Prodromal Stage
The initial appearance of symptoms,
though they are usually vague. They
may include malasis, fatigue, anorexia,
mild fever, myalgia, and headache. 
Flu like symptoms.
 ACUTE Stage
The maximum impact of the infectious
process; there is rapid proliferation and
spread of the pathogen. The symptoms
are more pronounced and specific.
 Convalescence
Infection is contained and being
progressively eliminated; The damaged
tissue is repaired. Symptoms are
decreasing.
 Resolution
Total elimination of the pathogen; no residual
signs and symptoms.
DEFENSES AGAINST INFECTION

 Normal flora
 Body System Defenses Inflammation
 VASCULAR AND CELLULAR RESPONSE
 EDEMA
 PHAGOCYTOSIS
 LEUKOCYTOSIS
 INFLAMMATORY EXUDATE
 SEROUS
 SANGUINOUS
 PURULENT
SPECIFIC DEFENSES AGAINST INFECTION

 CELL- MEDIATED IMMUNITY

immune cells -> intracellular antigens
(eliminates intracellular pathogens)
Tcells

 ANTIBODY-MEDIATED IMMUNITY
antibodies -> extracellular antigens
(eliminates extracellular pathogens)
B cells
 HEALTH CARE ASSOCIATED
INFECTION (NOSOCOMIAL)
 Infections that are a result of health
care delivery, not present at admission

EXOGENOUS
are the result of pathogens being spread by
patients as they are shed from various portals
of exit while the patients are in the health care
facility.
 ENDOGENOUS
are the result of opportunistic pathogens already present in
or on the body of the patient and brought on by conditions
present at or the direct result of activities at the health care
facility.

IATROGENIC
are spread by health care workers, generally as the
result improper sanitary conditions, failure to follow
universal precautions, or contaminated invasive surgical or
patient care equipment.
Common Health-Care
Associated Infections
 Urinary Tract Infection

 Surgical/Traumatic Wound Infection

 Respiratory Tract

 Bloodstream
The Nursing Process & Infection
Control (Assessment)
 Status of defense mechanisms
 Client Susceptibility
 Nutritional Status
 Stress
 Disease Process
 Medical Therapy
 Clinical Appearance
 Lab Data
Lab Data

 WBC Count

 Sedimentation Rate

 Cultures of sputum, urine, blood

 Differential Count
Assessing Risk for
Infection
 Age
 Disease Processes
 Lifestyle
 Occupation
 Diagnostic Procedures
 Medications
 Travel History
 Nutritional Status
Isolation Precautions
 CDC and OSHA Guidelines

1. Contact

2. Droplet

3. Airborne
Drug Resistant Organism
Infections &
Colonizations
 Methicillin-Resistant Staphylocuccus
aureus (MRSA)
 Vancomycin-Resistant Enterococcus
(VRE)
 Extended-Spectrum Beta Lactamase
(ESBL)
 Multi-drug Resistant Tuberculosis
Personal Protective
Equipment
 Gowns
 Respiratory Masks
 Eye Protection
 Gloves
 Specimen Collection
 Bagging Trash & Linen
 Transporting Patients
Current CDC Guidelines
 Standard precautions—used in care of all
hospitalized patients
 Apply to blood, body fluids, secretions, excretions,
non-intact skin, mucous membranes
 Transmission-based precautions—used in
addition to standard precautions for patients
with suspected infection
 Include airborne, droplet, or contact precautions
Neutropenic precautions-use for a patient
whose immune system is compromised

Examples: one recovering from a transplantation

surgery or receiving chemotherapy
Standard precautions are needed (as with all patients)
Provide a healthy caregiver
Restrict visits from friends or family members with
colds or contagious illnesses
Avoid standing collections of water in the room
 What is aseptic technique?

Aseptic technique means using practices and

procedures to prevent contamination from
pathogens. It involves applying the strictest rules to
minimize the risk of infection. Healthcare workers use
aseptic technique in surgery rooms, clinics,
outpatient care centers, and other health care
settings.
What is aseptic technique used for?
Following aseptic technique helps prevent the
spread of pathogens that cause infection.
Healthcare professionals commonly use
aseptic technique when they’re:

• handling surgery equipment

• helping with a baby’s birth by 
vaginal delivery
• handling dialysis catheters
• performing dialysis
• inserting a chest tube
• inserting a urinary catheter
• inserting central intravenous (IV) or arterial
lines
• inserting other draining devices
Surgical asepsis is the absence of all 
microorganisms within any type of invasive 
procedure. 

Sterile technique is a set of specific practices 
and procedures performed to make equipment 
and areas free from all microorganisms and to 
maintain that sterility
 Principles of Sterile Technique
Safety considerations:
• Hand hygiene is a priority before any aseptic procedure.

• When performing a procedure, ensure the patient understands how 
to prevent contamination of equipment and knows to refrain from 
sudden movements or touching, laughing, sneezing, or talking over 
the sterile field.

• Choose appropriate PPE to decrease the transmission of 
microorganisms from patients to health care worker.

• Review hospital procedures and requirements for sterile technique 
prior to initiating any invasive procedure.

• Health care providers who are ill should avoid invasive procedures 
or, if they can’t avoid them, should double mask.
 STEPS
1. All objects used in a sterile field must be sterile.

2.  A sterile object becomes non-sterile when touched by a 
non-sterile object.

3. Sterile items that are below the waist level, or items held 
below waist level, are considered to be non-sterile.

4. Sterile fields must always be kept in sight to be considered 
sterile.

5. When opening sterile equipment and adding supplies to a 
sterile field, take care to avoid contamination.
6. Any puncture, moisture, or tear that passes through a sterile 
barrier must be considered contaminated.

7. Once a sterile field is set up, the border of one inch at the edge of 
the sterile drape is considered non-sterile.

8. If there is any doubt about the sterility of an object, it is 
considered non-sterile.

9. Sterile persons or sterile objects may only contact sterile areas; 
non-sterile persons or items contact only non-sterile areas.

10. Movement around and in the sterile field must not compromise 
or contaminate the sterile field.
Aseptic technique vs. clean technique

The goal of the aseptic technique is to

eliminate germs entirely.

The goal of the clean technique is to reduce

the number of germs whenever possible.
Healthcare professionals
commonly use clean techniques
when they’re:

• giving an injection
• emptying a urinary catheter drainage bag
• giving a bed bath
• inserting a peripheral IV (an IV in a smaller
vein)
• removing a peripheral IV
• removing a urinary catheter
Patient Teaching for
Medical
Asepsis at Home
 Wash hands before preparing or eating food
 Prepare foods at high enough temperatures
 Use care with cutting boards and utensils
 Keep food refrigerated
 Wash raw fruits and vegetables
 Use pasteurized milk and fruit juices
 Wash hands after using bathroom
 Use individual care items